Wicked issues – complex problems that cannot be solved in a traditional fashion – are nothing new. But the current challenges facing the NHS, social care and others are arguably the most ‘wicked’ yet. There is a danger that the new models of care discussed in the Five Year Forward View will be implemented in ways which fail to recognise their inherent complexity.
A new report presents the findings from a research study which explores how we can better broker constructive conversations. This means having in-depth dialogues between people who commission and provide services and patients, service users and the public to tackle the most difficult issues associated with the implementation of new models of care.
The research was undertaken by the SCIE, working in partnership with PPL and the Institute for Government; and funded by the Health Foundation’s Policy Challenge Fund.
- Report: Changing together: brokering constructive conversations
- Blog: "Real and meaningful engagement with citizens"
- Dudley, which is implementing a Multi-Speciality Community Provider Vanguard, has used constructive conversations to access the views and ideas of service users on how to best transform its approach to end of life services. Case study: Dudley
- In Islington, Camden and Islington NHS Foundation Trust are trying create a radically different model of community based mental health, monthly ‘evolution’ groups involving service users are involved in decision making about the clinical strategy and service plans.Case study: Islington
- Mid Nottinghamshire has established a citizen’s board, made up of local service users and carers, to help inform its long term plans. Through engaging directly with senior managers, the Board has been able to act as ‘translators’ between patients / service users and professionals. Case study: Mid Nottinghamshire
Key messages: brokering constructive conversations at a whole system or service level
- There is no one-size-fits-all methodology at the system level
- Genuine co-production, deliberation and negotiation take time and resources
- The best results are achieved when the engagement process begins at an early stage of planning service change and is maintained during implementation.
Key messages: brokering constructive conversations at an individual, care planning level
- There is a need for constructive conversations with citizens not only at a system or service level but also at an individual, care-planning level
- Constructive conversations are critical to good, proactive care planning and, in turn, good care planning is essential for tackling wicked issues such as improving transfers of care and improving end of life care
Ewan King (pictured), SCIE's director of business development and delivery says: "We want to encourage in-depth dialogues between people who commission and provide services and patients, service users and the public - with citizens.
"This can help tackle ‘wicked issues’ - those really challenging and seemingly intractable issues - associated with the implementation of new models of care.
"Change on the scale being suggested cannot be ‘done to’ local communities – it needs to be negotiated with their close involvement through co-production and meaningful engagement."